The International Journal of Epidemiology just published a special supplement, edited by Anne Lovell and Ezra Susser and entitled “History of Psychiatric Epidemiology.” The supplement consists of an introduction by Lovell and Susser and five articles, the abstracts of which are below.
What might be a history of psychiatric epidemiology? Towards a social history and conceptual account
Anne M. Lovell and Ezra Susser
This supplement heralds the start of an interdisciplinary and international effort to trace the origins of psychiatric epidemiology. As a first step, these papers focus primarily on developments during the period 1945 to 1980, in the USA, UK and France, as well as internationally through the World Health Organization (WHO). A post-war modern epidemiology centred on risk factors emerged during this time.1 One exemplar of a ground-breaking study that advanced psychiatric epidemiology along similar lines is sociologist Lee N Robins’ 1960s investigation of the relationship between childhood behaviour problems and adult antisocial behaviour.2 The papers herein, however, show that despite such exemplars, these developments were uneven and highly contested within the distinctive sphere of psychiatric epidemiology. Often the debates brought to light are still relevant today, and some have implications beyond psychiatric epidemiology.
This paper focuses on the relatively late emergence of psychiatric epidemiology as an international discipline, through local-global exchanges during the first 15 years of the World Health Organization (WHO). Building an epidemiological canon within WHO’s Mental Health Programme faced numerous obstacles. First, an idealist notion of mental health inherent in WHO’s own definition of health contributed to tensions around the object of psychiatric epidemiology. Second, the transfer of methods from medical epidemiology to research on mental disorders required mobilizing conceptual justifications, including a ‘contagion argument’. Third, epidemiological research at WHO was stymied by other public health needs, resource scarcity and cultural barriers. This history partly recapitulates the development of psychiatric epidemiology in North America and Europe, but is also shaped by concerns in the developing world, translated through first-world ‘experts’. Resolving the tensions arising from these obstacles allowed WHO to establish its international schizophrenia research, which in turn provided proof of concept for psychiatric epidemiology in the place of scepticism within and without psychiatry.
This article takes up the history of North American psychiatric epidemiology with reference to production of knowledge concerning sociopathic or antisocial personality disorder and drug dependence, abuse, and/or addiction. These overlapping arenas provide a microcosm within which to explore the larger shift of postwar psychiatric epidemiology from community studies based on psychological scales to studies based on specific diagnostic criteria. This paper places the figure of sociologist Lee Nelken Robins within the context of the Department of Psychiatry in the School of Medicine at Washington University in St Louis, Missouri. The St Louis research group—to which Robins was both marginal and central—developed the basis for specific diagnostic criteria and was joined by Robert Spitzer, Jean Endicott and other architects of DSM-III in reorienting American psychiatry towards medical, biological and epidemiological models. Robins was a key linchpin working at the nexus of the psychiatric epidemiological and sociological drug addiction research networks. This article situates her work within the broader set of societal and governmental transformations leading to the technologically sophisticated turn in American psychiatric epidemiology and research on the aetiology of drug abuse and mental health and illness.
Social disorder and diagnostic order: the US Mental Hygiene Movement, the Midtown Manhattan study and the development of psychiatric epidemiology in the 20th century
Dana March and Gerald M. Oppenheimer
Recent scholarship regarding psychiatric epidemiology has focused on shifting notions of mental disorders. In psychiatric epidemiology in the last decades of the 20th century and the first decade of the 21st century, mental disorders have been perceived and treated largely as discrete categories denoting an individual’s mental functioning as either pathological or normal. In the USA, this grew partly out of evolving modern epidemiological work responding to the State’s commitment to measure the national social and economic burdens of psychiatric disorders and subsequently to determine the need for mental health services and to survey these needs over time. Notably absent in these decades have been environmentally oriented approaches to cultivating normal, healthy mental states, approaches initially present after World War II. We focus here on a set of community studies conducted in the 1950s, particularly the Midtown Manhattan study, which grew out of a holistic conception of mental health that depended on social context and had a strong historical affiliation with: the Mental Hygiene Movement and the philosophy of its founder, Adolf Meyer; the epidemiological formation of field studies and population surveys beginning early in the 20th century, often with a health policy agenda; the recognition of increasing chronic disease in the USA; and the radical change in orientation within psychiatry around World War II. We place the Midtown Manhattan study in historical context—a complex narrative of social institutions, professional formation and scientific norms in psychiatry and epidemiology, and social welfare theory that begins during the Progressive era (1890-1920) in the USA.
This article uses archival as well as published materials to trace the development of psychiatric epidemiology in France from 1945 to 1980. Although a research programme in this field was launched in the early 1960s at the National Institute of Medical Research (INH, later renamed INSERM), psychiatric epidemiology remained an embryonic field in France during the next two decades. French researchers in this field were hampered by limited resources, but their work was primarily characterized by a deep engagement with the epistemological challenges of psychiatric epidemiology. The history of French psychiatric epidemiology in the 1960s and 1970s can be seen as an attempt to create a specifically French way of doing psychiatric epidemiology research. In the first part of this article, the author relates this unique history to internal professional dynamics during the development of psychiatric research and, more broadly, to the biomedical institutional context in which epidemiological work was being done. The next part of this article examines the conditions under which the INH research team framed epidemiological research in psychiatry in the 1960s. The last part focuses on INH’s flagship psychiatric epidemiology programme, developed in cooperation with pioneers of French community psychiatry in Paris’s 13th arrondissement in the 1960s.
Psychiatric epidemiology, or the story of a divided discipline
This article traces the historical decisions, concepts and key professional collaborations that laid the foundations for the formation of American psychiatric epidemiology during the 20th century, up to the discipline’s institutional consolidation, circa 1980, when the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was published. Thomas Kuhn’s ‘disciplinary matrix’ is mobilized as a framework that allows the institutional and intellectual construction of a discipline to be analysed as separate but intertwined components, without assuming that the two evolve in tandem. The identification of the strengths as well as the frailties and internal divisions of the discipline as it developed reveals a paradoxical situation: a time lag between psychiatric epidemiology’s institutionalization and public recognition, on the one hand; and the weak coherence of its intellectual components, on the other hand. We briefly trace the origins of split among the discipline’s aetiological models of mental disorders and suggest that the lack of coherence among them has prevented psychiatric epidemiology from achieving the status of a normal scientific discipline, in the Kuhnian sense. Without a more explicit attention to the intellectual rationale of the discipline, psychiatric epidemiology will continue to maintain a strong institutional dimension and weak intellectual matrix.
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